Dr Alvin Ng Chee Keong
Cardiologist
Adjunct Asst Professor, Yong Loo Lin School of Medicine, National University of Singapore
MBBS (S'PORE), MRCP (UK), FACC (USA), FAMS (S'PORE)
CORONARY ARTERY DISEASE
- What it's all about
Whilst there is no universal agreed nomenclature, intervention generally refers to a surgical procedure. Coronary intervention would refer to surgery procedure for the arteries. Cardiac intervention can refer to surgery to other heart structures like the electrical system or the heart valves.
In Singapore’s medical training system, selected doctors who have fulfilled certain criteria would undergo sub-specialized training. In the case of cardiology, these areas would include coronary intervention, electrophysiology study and treatment of cardiac rhythm problems, implantation of pacemaker devices, cardiac valve surgery.
Most doctors only receive 1 of such sub-specialty training in their careers. In addition, it is usually prestigious to experience such training in an overseas centre that provides complete experiences in those areas of interests. Dr Alvin Ng received 3 such overseas training. The first was in Sydney. This was followed by Cardiac Imaging in Cedars Sinai Hospital, USA. In 2006, he was sent for his training in Intervention Cardiology at Johns Hopkins Hospital, USA.
Non-invasive blood vessel Reactivity, a Basic Science
Adjunct Asst Prof Alvin Ng learnt the technique of brachial artery reactivity assessment from world renowned expert Professor David Celermajer, Royal Prince Alfred Hospital, Sydney in the year 1999. Dr Ng then wrote a paper using this technique to assess the impact of various food groups on this area of basic science. It is widely believed atherosclerosis or plaques of arteries (blockages) start from an unhealthy endothelium (inner lining of arteries). Beyond clinical practice, Dr Ng was curious about basic science. He is also grateful for his students who participated as his ‘lab rats’.
Common Cardiac Symptoms
Often, there is confusion about tests that are done to assess heart problems. Common symptoms attributed to the heart include Chest Discomfort, Palpitations and Shortness of Breath. People experience the same condition differently. Therefore, when uncertain it is prudent to seek professional advice and examination. These professionals include family doctors and specialists.
Electrocardiogram or ECG
This test is the most basic test to measure the electronic pattern of the heart rhythm and sometimes, to see cardiac problems that have happened in the past or are presently happening. In fact, certain non-medical devices are beginning to be able to achieve medical standards of measurements. Below is an example of a person who’s experienced abnormal heart beating for a decade. He has even consulted specialist doctors but the condition was not discoverable, until a wrist device was able to identify the problem:
Seeing the symptoms is a necessary step to diagnosing such a condition. The common symptom for the above is Palpitations.
CORONARY ARTERY EVALUATION WITH AN ANGIOGRAM
AND TREATMENT WITH BALLOONING AND STENTING
The presence of ‘blockages’ is 60% predicted based on common risk factors like Diabetes Mellitus Hypertension, High Cholesterol, Family History, Tobacco use, Obesity Sleep apnoea, etc. There are many who have silent blockages that are not discovered till too late. There is no consistent approach to this problem. Everyone has a different perception of their health risk. Some prefer to wait for care when an emergency beckons. Others are health-seeking. Other than an ECG, other modalities like treadmill test, echocardiogram test at rest or with stress, cardiac nuclear imaging and CT scan can be used to evaluate the presence of coronary artery disease.
Adjunct Asst Prof Alvin Ng spent a year studying all the above at Cedars-Sinai Hospital, USA with Prof Dan Berman. The experience enables Dr Ng to provide individualized advice and care, including the appropriate test and risk profile optimization to either detect, treat coronary artery disease before coronary artery disease causes irreparable damage to the heart.
The patient below was actively exercising and without typical chest discomfort. Due to close attention paid to his risk profile, serious coronary artery disease was discovered using cardiac CT scan, thereby avoiding an unexpected sudden cardiac event: 90% block of a large Right Posterior Descending Artery.
This patient received immediate attention and the following pictures review the treatment he received with the procedure known as coronary angiogram and stenting:
90% Blockage
Balloon Angioplasty
After Stenting
Adjunct Asst Pro Alvin Ng received his formal training in coronary intervention at the prestigious Johns Hopkins Hospital, USA. Under the guidance of excellent teachers like Drs Jon Resar, Jeff Brinker, Alan Heldman, Dr Ng acquired important skills and experience to manage coronary artery disease, both simple and complex, with emphasis on safety. The importance of overseas training is also to acquire knowledge from different masters of the field and the management of unusual cases and complications. Again, Dr Ng has been blessed to have received training opportunities thrice in various aspects of atherosclerosis and to be a bona fide coronary interventionalist, to provide treatment when coronary artery disease failed risk factor modification or disease progressed.